My visit to the GP yesterday went well on the whole. Within two hours I had seen the doctor, been to the hospital to get some X-rays taken, visited the pharmacy to get some pills and returned home again. I even had wondered around a supermarket to “waste” some time between the doctor’s surgery and the X-ray department. Plus, I accomplished all that travel on foot. With a sore right big toe. It was a lovely sunny day, and I enjoyed my plodding around my neighbourhood.

What I didn’t enjoy was the examination of the joint of my right big toe and the foot. I really must look up the name for this joint. I pointed out to my GP the area that hurt. I had the feeling that this was a bit unusual because only the top left bit of the joint hurt. He got me to pull my toe towards myself and then push against his thumb. This didn’t hurt me. I pointed out the pulling up of my toe was what hurt me. I was staring at my toe but I could tell he was looking for a response to pain on my face. It reminded me of the physio commenting on transplant patients having a much higher threshold for pain. I don’t think my GP is familiar with this phenomenon. He squeezed the joint area until I cried out in pain. My joint felt a lot worse after this treatment.

I left his room a bit bewildered by the experience. Looking back I wish I had challenged him to explain his methods. It feels a bit that he doesn’t believe me when I talk about pain and we are miscommunicating a bit. Perhaps I have the need, to at least get him to listen to my point of view and perhaps understand his better.

Strangely enough, I came across an app online that allows you to graphically draw your pain on a body. It allows different intensity of colour to show degrees of pain plus you can make notes on other side phenomena. It’s called Geopain and can be found in the usual places for both Android and Apple phones. I think Geopain is good thing for some people but personally I don’t think of my pain in terms of colour intensity so for me I still need to figure out how to translate my experience into a scale. The app did get me thinking about how I would come up with a scale.

I have been asked in the past by folks how much of something has happened. So, how much pain I am in on a scale of one to ten? Or how happy I am on a scale of one to ten? Or in a different vein how much blood did I vomit up? Each time I have been flummoxed as to how to answer. I need a scale to compare against. It might have been two cups of blood that was produced but unless I throw something similar to two cups of blood at high speed into a toilet bowl, I have no experience to compare the real cast to. So I think it would be good for me at least, to have a scale for pain.

I am going to concentrate on basing this scale on my big toe experience within the context of my life. I hope perhaps to extend the scale to cover other types of pain but first things first. When I think about my joint pain, I think there are definite crossing points on the scale.

First there is no pain at all, which I would equate to zero on the scale. The next stage up is when there is pain but I need to sit quietly and concentrate to recognise it. Next up is the pain I am conscious of but which doesn’t change how I behave in most of life. Next up is pain that I changes a frequent behaviour somehow. This is followed by pain that impinges on my consciousness so much, that I want to take everyday painkillers to take the edge of it. I can bear the pain but it is distracting me from doing things. I think the next stage is pain that consumes all my thoughts, it demands that I do something about it and nothing else matters. I take multiple everyday painkillers and isolate myself to cope with the pain. The next stage is where everyday painkillers and isolation fails because the pain is too much for my brain to handle. I need to take heavier duty analgesics and preferably sleep because the pain wears down my control to an extent that I do not know how much longer I can take of it. I need external help at this point to cope really, though usually I can weather the storm if the painkillers start having an effect. Once the pain itself is under some control, this level still demands that I remain as still as possible in order to not trigger more pain.

So to give some examples:

  • I am aware of pain in several finger and toe joints on my left side but I need to sit quietly and concentrate to positively recognise them.
  • My right hand thumb joint is hurting but it doesn’t stop me doing anything unless I put great pressure on it like using a screwdriver which I don’t do too often.
  • My right knee joint is in near constant pain at the moment. I have to concentrate when I walk, sitting or lying down to keep my leg aligned or supported well because otherwise it is uncomfortable enough to stop me doing other things.
  • My right big toe joint is continuously painful and after running or being examined by a GP, I feel the need to take some pain killers because I have problems concentrating.
  • Taking multiple painkillers and isolating myself is probably not something on my joint pain scale, but certainly occurs with migraines.
  • My experience of an acute gout-like attack falls under my last category. I am unable to absorb/contain the pain and it comes out in movement and wanting to cry out. I wonder how long I can take this because standard pain relief is not working

What I am becoming aware of, is that there is a definite mental aspect to the pain scale I am talking about which goes along the lines of unconscious, conscious, partial interruption, total interruption and distress. I think there could also be partial distress, where the feeling of control comes and goes, and full distress when it feels like one’s control is going to run out soon.

Though perhaps this is abstracting too soon because my mind is finding it a bit complex to contain an actual experience and possibly the generalisation. I keep getting side tracked into comparing with other situations.

I want to finish this piece so let me finally state a scale:

Scale Pain Description
1 Pain recognised through concentrated thought
3 Conscious of pain but generally non-interfering
5 Pain interferes with common tasks
7 Pain requires some standard analgesic
9 Pain requires specialist analgesic
10 Unbearable pain requiring specialist intervention

I wonder how this compares to other people’s experiences? I’d be interested to hear from you if you’d gone through a similar thought process to develop your own scale. How do you cope if your doctor asks you to scale something?